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Why America’s Ongoing Heroin Epidemic May Soon Run Its Course

Heroin use has increased 63 percent over the past decade, but experts believe it's only a matter of time until the drug's popularity begins to fade.
Photo by David Ryder/Reuters

New data from the Centers for Disease Control and Prevention (CDC) shows a staggering increase in heroin abuse in the United States — particularly among women and wealthy Americans — but some addiction experts say there is hope that the drug's popularity will soon follow the pattern of previous addiction cycles and begin to fade.

According to the CDC's new data, heroin abuse has increased 63 percent over the past decade, and the number of heroin overdoses has doubled. The demographics providing the most new users are women and people with higher incomes and private insurance. The surge in heroin addiction has received extensive media coverage — with many headlines characterizing the phenomenon as an "epidemic" — and some states have taken emergency measures, such as making the overdose prevention drug Naloxone more widely available, to address the rise in heroin-related deaths.


But while it seems there's been an unending tide of news about the the worsening situation, some drug experts say the problem will eventually run its course. The silver lining to the CDC's new data was first mentioned by Dr. Brad Lander, clinical director of addiction psychiatry at Ohio State University's Wexner Medical Center, who told HealthDay that drug epidemics "go in cycles" and the heroin epidemic "will disappear over time."

Lander told VICE News that he's been working in the field of drug addiction for 33 years, and has seen many different drugs wax and wane in popularity during that time. "This is comparable to the crack epidemic we had around 1985," Lander said. "A lot of patients at that time were coming in because of crack addiction. After there was enough public outcry, people stopped getting into it as much. Then we've seen ecstasy, then we had a big problem with bath salts, and now we've got heroin. It's a huge, massive problem, but my experience tells me over time this will go away."

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Lander said that heroin still seems to be spreading, though he hopes the drug is beginning to reach peak popularity. "We've got a ways to go before this bubble bursts," he said.

Cocaine and crack were frequently cited as other examples of drugs that have cycled through popular and unpopular phases, with Lander noting that heroin abuse was very low in the early 1990s when cocaine was many people's drug of choice.


"Cocaine [abuse] is certainly much lower than it has been," Theodore Cicero, an opioid researcher and psychiatry professor at Washington University in St. Louis, told VICE News. "It was the drug of choice in the '90s and was very popular. I think as there were more overdoses and people suffered more complications, there's been decrease in cocaine use occurring in country. There's been waxing and waning. Unfortunately, heroin and opioids have filled some of that void."

'It's a huge, massive problem, but my experience tells me over time this will go away.'

Addiction researchers have studied what causes drugs to spike in popularity, and what factors lead to a fade from trendiness. Jonathan Caulkins, a public policy research at Carnegie Mellon Univeristy who has worked with RAND's Drug Policy Research Center, led a study published in 2005 about the "oscillation" in drug usage in the US. His team found that "drug use varies over time in ways that have long been described in terms of 'epidemics,'" including heroin and cocaine epidemics from 1880 to 1920 that died out, remained low for 50 years, and then resurged in the late 1960s and early 1970s.

Lander similarly pointed out that cocaine's popularity in the late 1800s eventually faded when people saw the negative consequences of use and the drug became socially unacceptable.

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Caulkins said that the epidemic comparison is useful for thinking about how drugs become popular. "This metaphor is appropriate even though there is not literally a pathogen, as with HIV or cholera, because most initiation occurs through contact with current users, not at the urging of drug sellers," he wrote.

A drug's popularity begins to diminish when negative feedback gains the upper hand, either through word of mouth reports, bad experiences, or public attention to overdoses and other dangers. He also found that policies aimed at preventing new users and treating current users both help lessen a drug's appeal.

"As publicity of heroin overdoses and the severity of the use of heroin makes its way through word of mouth, which matters on the street, it may communicate the dangers of going in that direction," said Cicero, the Washington University professor.

But heroin's connection to prescription painkiller use cannot be overlooked, experts said.

"The one thing I think that's disconcerting about opioids is that because of the increase in use that is coming from prescription opioids, they've become a lot more available than they used to be," Kimberly Kirby, an addiction psychologist at the Treatment Research Institute in Philadelphia, told VICE News. "A number of steps are now being made to try and teach people to prescribe them differently so there are not as many out there on the streets. I would guess if the availability of prescript of opioids does decrease you would see reduction in use. The scary thing is there could be a lot of deaths before that."


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All three addiction specialists said that there needs to be increased attention paid to treatment, including reducing the stigma of seeking help, and also finding new medical treatments for opiate addiction. Kirby cited the development of naltrexone, which blocks a user from feeling high from opiates, as a step in the right direction.

"I think the awareness," Lander said when asked what would help curtail heroin use. "The things that matter are how dangerous do people think it is, are their friends using it, the social acceptance of it. You can educate on both of those. This is actually what happens when you use opiates for a period of time. There is social disapproval of it. It's not cool, not an okay thing to do. It's a problem and it's destructive and so on."

Follow Colleen Curry on Twitter: @currycolleen

Watch the VICE News documentary, Back From The Brink: Heroin's Antidote: